The Prevention Works : Vol.2 Issue 3

Neighborhood revitalization

‘Project Revitalization’ in Vallejo, California, has developed a comprehensive strategy to address alcohol and other drug related crime in the city’s worst areas. The project relies on a strong community partnership comprised of Vallejo Fighting Back Partnership, Vallejo Code Enforcement, Vallejo Chamber of Commerce, Vallejo Police Department, Vallejo Neighborhood Housing, California Employment Department, the Private Industry Council, and neighborhood associations.
By integrating neighborhood revitalization, alcohol policy, neighborhood safety, job training, and coordination of human services into a comprehensive effort, the project aims to reduce code violations and police calls for service and to improve safety and the quality of life of residents in deteriorating crime-ridden neighborhoods.

Project Revitalization is based on the following four complementary premises:

• The physical makeup of a community has an important influence on its vulnerability to crime. Physical signs of disorder and illegal activities in a neighborhood such as abandoned cars, problematic liquor stores, drug dealing, and deteriorating housing invite crime and disorder if left unchanged.
• Neighborhoods where residents have some level of commitment and shared interest in improving their environment can influence the level of crime.
• Individuals and families must personally gain from the revitalization of an area. When people are drowning in problems such as unemployment, addiction, lack of childcare, and other social service needs, it is unrealistic to expect their engagement in improving their neighborhoods.
• Problems with alcohol can and do contribute to the overall level of area deterioration and require appropriate enforcement and policy interventions.

A Five-Step Process
Revitalization is a five-step process beginning with assessment and ending with ongoing evaluation. While the following steps are presented somewhat in sequence, overlap and intentional repetition is inherent in the process.

Initial problem assessment
The project relies on a block-to-block component, which is designed to accurately determine which areas of the city are the worst hot spots for crime, violence, and physical deterioration. To accomplish this, we rely on the use of the Alcohol/Drug Sensitive Information Planning Systems (ASIPS), coupled with a Geographic Information System (GIS).
ASIPS, a planning tool developed by CLEW Associates in Berkeley, CA, engages the Vallejo Police Department to identify alcohol and drug involvement in every call for service. Officers end their calls to dispatch with a three digit alpha numeric indicator that identifies whether alcohol or drugs – both or neither – was involved in the call for service. For example, the code A11 means “alcohol in a single family detached residence.”
This simple process yields a tremendous amount of information about the nature of the call, as well as the location and setting of the event. Calls for service that are alcohol or other drug-involved are then mapped through the GIS. These maps graphically depict where crimes occur and provide project workers with the locations in the city to move to the next phase of assessment.

Additional assessment
After identifying potential hot spots, project workers visit each of the areas to assess the level of physical deterioration of housing in the surrounding environment, which often acts as a magnet for certain criminal and social problems. In the final assessment stage to select target neighborhoods, project staff speak with residents to see if they are interested in working in a revitalization process.
Staff members contact neighborhood associations – if they exist – to discuss the project. Areas are not selected unless residents invite the project in and are committed to participating in the process.

Initial intervention
Once areas are selected, the intervention phase begins. It includes the following components:

• Law Enforcement. Often, problem residences where illicit activity occurs are part of neighborhoods that suffer from crime and physical deterioration. These locations have an effect on the willingness of neighbors to interact socially and form the social structures that can be effective in reducing problems. Therefore, it is important for law enforcement, as part of the early stages of the project, to weed out these locations and create a safe environment for residents. Part of this weeding effort involves the police in towing abandoned vehicles. This action alone creates a significant improvement in the quality of the neighborhood and begins to prove that the revitalization effort is serious about improving the quality of life for residents.

• Code Enforcement. Concurrent with the law enforcement effort, code enforcement staff engages in a residence-by-residence appraisal of building code violations.

• Community Organizing. During this stage, community organizers begin to establish relationships with residents in order to better understand each individual’s social service and employment needs.

Full implementation
As the police engage in various law enforcement activities to address crime and violence in project neighborhoods, streets become safer. This transition slowly increases the feeling of safety on the part of residents and work on forming a neighborhood association or block watch can proceed. In addition, the community organizer can deepen personal relationships with residents and begin the social service work in earnest. Residents are organized to create political pressure for stores to clean up their acts.
_________________________________________________________________
‘Project Revitalisation’ – Vallejo – Project elements:

Residents Code Enforcement
Industry Community
Employment Housing
Police Commerce
________________________________________________________________
Code enforcement staff work with homeowners and renters to bring property up to city standards. Together, they form plans about how homes can improve beyond minimum city requirements. Code enforcement is critical in this process for it holds the legal tools to cite owners that refuse to voluntarily cooperate with the revitalization process. During this stage of the intervention, all project agencies and organizations are also organizing a clean-up day during which large numbers of volunteers from all over the city work with residents to paint, haul debris, build fences, do carpentry, and cut and trim landscaping – performing essentially a neighborhood make-over. Clean-up days include a barbecue to further cement relationships between neighbors, volunteers, and project workers.
Neighborhood stability
The final phase can last from 6 to 9 months. After the clean-up, the community organizer steps up efforts to work with the residents to form a neighborhood group and to adopt a set of community standards to serve as the basis of how the area should be maintained in the future. The organizer also continues to work with the residents to help them get whatever services they need to improve the quality of their lives.

Project results
How is this process working? To date, work has begun in two areas of Vallejo (Alabama Street and Springs Road) and the results look promising. The first project area – Alabama Street – was a test to determine if the process was viable. The neighborhood experienced a reduction in police calls for service and improvement in the perception of safety on the part of residents.

The second neighborhood revitalization project in Springs Road was much larger in scope than the first project. Started in November 1997, the Springs Road project is in the final stages of implementation. This ambitious and far-reaching project featured joint efforts of many partners. On its clean-up day, streets were blocked off as teams of volunteers painted, trimmed trees, rebuilt fences, swept and hauled away debris and weeds. More than 225 people signed up to work during the day. Highlights included the live broadcast of music and interviews of residents by Radio KDIA and a barbecue for all participants. In all, 22 dumpsters of trash were hauled away, totaling over 37 tons; 6 old vehicles were towed; and more than 50 residences were worked on. But the day is as much about bringing neighbors and volunteers together as a real community as it was about a clean up.

The role of policy
Alcohol policy and other policy development are critical to the long-term success of this effort. Helpful policies include:

• A conditional use permit for alcohol outlets to regulate new outlets
• An approved ordinance for alcoholic beverage establishments to regulate existing outlets
• A teen party ordinance to reduce non-commercial access of alcohol to minors
• A social nuisance ordinance to hold non-compliant property owners accountable to a standard of property maintenance and resident conduct
• A rental inspection ordinance.

These policies help neighborhoods proactively address problem properties before they become nuisances and are part of the structural changes required to sustain the positive neighborhood changes that result from the revitalization process. Based on early results, the revitalization project is about to move into its third and fourth neighborhoods. Ultimately the project will engage between 10 and 15 neighborhoods. Real, sustained improvements in people’s lives are the mark of success for this project. Will residents assume long-term responsibility for their environments? Can this effort reduce crime citywide? And can the project continue with the broad base of support it currently enjoys? In perhaps a year, these and other important questions will be answered.

Source: Michael Sparks – Michael is the director Of Project Revitalization. He can be reached by e-mail at SPARKS@SONJC.NET – Reported in Prevention Pipeline Sep/Oct 1998

Prevention Works!

Data from the past 20 years show that prevention has succeeded in substantially reducing the incidence and prevalence of illicit drug use. Successful substance abuse prevention also leads to reductions in traffic fatalities, violence, unwanted pregnancy, child abuse, sexually transmitted diseases, HIV/AIDS, injuries, cancer, heart disease and lost productivity.

Substance Abuse Prevention can be shown to be effective. In 1979, 25 million Americans used an illegal drug during the preceding month. (SAMHSA National Household Survey) In 1995, 12.8 million Americans used an illegal drug in the past month, a decrease of nearly 50 percent. In the 1980s, complete abstinence from drugs was claimed by fewer than one in thirteen high-school seniors. (NIDA–Monitoring the Future Survey) In 1995 nearly one out of five seniors reported complete abstinence, an increase of nearly 250 percent. Examples of Prevention Findings from CSAP national cross-site evaluations, CSAP grantee evaluations, and other programs.

FINDING:
Prevention programs can encourage change in youth behavior patterns which are indicative of eventual substance abuse.

Cornell University researchers in a study of 6,000 students in NY State found that the odds of drinking, smoking, and using marijuana were 40% lower among students who participated in a school-based substance abuse program in grades 7-9 than among their counterparts who did not.
Forty-two schools in Kansas City, MO reported less student use of alcohol, tobacco, and marijuana than control sites as a result of Project Star, a prevention program.
In Nashville, the proportion of students who achieved perfect attendance for 20-day attendance periods increased from 27% to 60% as a result of a CSAP-funded community partnership school incentive prevention program.
FINDING:
Substance abuse prevention programs can improve parenting skills and family relationships.
A CSAP-funded study at CO State University found significant and enduring enhancement of successful parenting skills including: increased parental satisfaction, decreased harsh punishments for children, increased positive attitudes towards parenting, and increased appropriate control techniques.
FINDING:
Drug abuse prevention programs are effective in changing individual characteristics which are predictive of later substance abuse.
In Oakland, CA and other sites across the country, the Child Development Project found significant decreases in incidents of weapons possession and gang fighting among program participants in comparison to control groups.
FINDING:
Substance abuse prevention programs reduce delinquent behaviors among youth which are frequently associated with substance abuse and drug-related crime.
The Mexican-American Unity Council found significantly fewer conduct problems, less hyperactive behavior, and reduced passivity among children participating in a CSAP-funded prevention program. A similar study in Denver, CO replicated these results.
The Safe Streets Prevention Partnership in Tacoma, WA has been instrumental in closing 600 drug selling locations since 1990 and in reducing crime by more than 40%.
The Miami Coalition Community Partnership program has spurred Dade County community officials to demolish more than 2000 crack houses. Crime in the area has been reduced 24% and annual drug use has decreased by more than 40%.
FINDING:
The transmission of generic life skills is associated with short-term reductions in substance abuse among adolescents.
In DE, the Diamond Deliveries program which targets pregnant adolescent alcohol and drug users resulted in a 60% lower incidence of low-birth-weight babies and significantly lower neonatal costs than a matched control group.
CSAP’s High Risk Youth projects confirm that prevention efforts incorporating “life skills” such as problem-solving, decision-making, resistance against adverse peer influences, and social and communication skills are associated with reduced incidence of substance abuse among adolescents.
Source: CSAP (Center for Substance Abuse Prevention) – www.health.org – Apr/1999

Preventive education for adolescents or children

What is preventive education for adolescents or children?
One of the most popular forms of ATOD (Alcohol, Tobacco and Other Drugs)prevention is preventive education for adolescents or children. Youth in classrooms or other community settings are presented with preventive lessons by a teacher, preventionist, trained police officer, or other authority. Often, trained teen volunteers may co-present a lesson. Lesson content may include ATOD information, life skills, or other components. (Note: Preventive education is just one way that schools play a prevention role. See the U.S. Dept. of Education’s list of “Characteristics of a Safe, Disciplined, and Drug-Free School,” in Appendix E of this Best Practices Handbook.)

Why does preventive education work?
Different kinds of curricula are based on different premises. Some seek to remedy a lack of drug information. Some seek to develop decision-making and resistance skills. Some seek to help adolescents counter pro-drug social influence as the youth establish their attitudes about ATOD. Research indicates that only some of these premises are valid.

How effective is preventive education for adolescents or children?
Preventionists have long been aware that preventive education alone is inferior to a more comprehensive approach that includes a focus on parents and community. Even so, preventive education as a sole approach has been one of the most heavily researched approaches to ATOD prevention. As a result of cumulative research, particularly in the 1980s and early 1990s, the evolving consensus of researchers in the field is that:

1. Given the correct curriculum, implementation support, and teaching approach, preventive education can have a significant positive effect in terms of delaying or preventing youth ATOD use.
2. Most currently used preventive education materials are NOT among the effective ones. But, they continue to be used due to political support, low cost, or other factors.
What else does research tell us about preventive education?
For adolescent education, two key research sources are Tobler and Stratton (1997) and Hansen (1996). Following earlier (1986 and 1992) meta-analysis studies of drug prevention programs, researcher Nancy S. Tobler conducted a meta-analysis of 120 experimental or quasi-experimental school-based adolescent drug prevention programs (5th-12th grade) that evaluated success on self-reported drug use measures. Each program was classified as either interactive (included guided discussion among students) or non-interactive (included only a lecture and discussion with the class facilitator).
Tobler found a tremendous difference in effectiveness, with non-interactive programs having little impact but the interactive programs having a substantial impact. Surprisingly, this impact on drug use occurred even when the average program length was only 10 contact hours.

Content categories of the various programs also played a role in effectiveness. Programs that focused only on intrapersonal skills such as decision-making, goal setting, and values clarification were ineffective. Effective programs may have had some intrapersonal skills, but included a strong interpersonal skill component focused on dealing with peer influence. Even with this content, programs delivered in a non-interactive way were substantially less effective, and frequently ineffective.

Another attribute, program size, was unexpectedly found to play a significant role in effectiveness. ‘Small” interactive programs did much better than “large” interactive programs, even though the latter did better than small non-interactive programs. The Tobler article does not define “small” and “large”, but a sub-analysis with “extremely large programs” may be used to infer a cutoff of about 1,000 students between the two categories.

Tobler’s meta-analysis used self-reported drug use as the sole measure of effectiveness, but “mediating variables” including knowledge and attitudes were also measured. An interesting point about the pattern of results on these measures is that interactive and non-interactive programs were approximately equal in producing knowledge gain, but interactive programs were superior in changing attitudes and decreasing use.

William Hansen’s summary of work in progress indicates that the three most powerful curricular elements in ATOD prevention are:

1. Normative Beliefs. Youth tend to greatly overestimate the percent of peers who use drugs. When given actual numbers, they apparently feel less deviant in their non-use.

2. Life Style Compatibility. In spite of hearing about the negative effects of drugs, many adolescents don’t necessarily see any threat by drug use to their desired lifestyle. When these connections are explicitly made, it has an impact.

3. Commitment. Opportunities for adolescents to make a personal, public commitment to avoiding ATOD use can lead to lower use rates.

For preventive education of younger (elementary school) children, the National Structured Evaluation indicates that a “Psychosocial Skill” approach is best. The approach is congruent with a “youth development” model, emphasizing affective, social, and other skills. It includes no didactic ATOD education. Examples of beneficial life skills for prevention include resistance skills, assertiveness, social problem solving, and decision-making.

Source: Best practices in ATOD prevention: US Dept. of Health & Human Services, National Inst. Of Health. 1997
Evidence Accumulates That Long-Term Marijuana Users Experience Withdrawal

Laboratory studies have shown that animals exhibit symptoms of drug withdrawal after cessation of prolonged marijuana administration. Some human studies have also demonstrated withdrawal symptoms such as irritability, stomach pain, aggression, and anxiety after cessation of oral administration of tetrahydrocannabinol (THC), marijuana’s principal psychoactive component. Now, NIDA-supported researchers at McLean Hospital in Belmont, Massachusetts, and Columbia University in New York City have shown that individuals who regularly smoke marijuana experience withdrawal symptoms after they stop smoking the drug.
“These studies suggest that in real-world situations abstinence from daily marijuana smoking creates withdrawal symptoms similar to those of other drugs of abuse,” says Dr. Jag Khalsa of NIDA’s Center on AIDS and Other Medical Consequences of Drug Abuse. “Marijuana smokers may continue to use the drug to prevent the irritability and discomfort they experience when they stop.”

Aggression
Dr. Elena Kouri and her colleagues at the Biological Psychiatry Laboratory at McLean Hospital found that long-term heavy marijuana users became more aggressive during abstinence from marijuana than did former or infrequent users. Previous studies of withdrawal symptoms have relied largely on patients’ subjective reports of a range of symptoms, Dr. Kouri notes. “We studied measurable changes in one specific symptom-aggression,” she says.

The researchers recruited two groups of male and female volunteers: 17 current long-term users of marijuana and a control group of 20 infrequent or former users. Current long-term users were smoking marijuana daily at the time of recruitment and had smoked marijuana at least 5 000 times – the equivalent of smoking once each day for more than 13 years. The infrequent or former users had not smoked more than 50 times in their life and had smoked less than once per month in the past year, or had formerly smoked at least daily but had not smoked more than once per week for the past 3 months.

“The results demonstrate that abstinence is associated with unpleasant behavioral symptoms that may contribute to continued drug use.”
At the beginning of the study, all participants were instructed to refrain from any marijuana use for 28 days. Abstinence was monitored by analysis of daily-observed urine sampling. Cigarette smokers were allowed to continue their usual tobacco use.
Aggression was measured on the first day of the study and after 1, 3, 7, and 28 days of abstinence. To measure aggression, the researchers used a 20-minute computerized test that participants were told would measure motor skills and other physiological characteristics. Participants were told that pressing one button in a certain pattern would add points to their score and that pressing another button would subtract points from the score of their opponent, who could similarly add or subtract points.

In fact, Dr. Kouri says, there was no human opponent; the computer was programed to subtract points randomly in order to give the illusion of a human opponent. At the end of each session, aggressive responses – those that subtracted from the supposed opponent’s points – were compared with non-aggressive responses – those that added to the participant’s points. Dr. Kouri notes that studies involving parolees with a history of violent behavior have shown a close correlation between performance on this game and actual aggression.

After 1, 3, and 7 days of abstinence, current marijuana users registered significantly more aggressive responses – more than twice as many on days 3 and 7 – than the control group. By the 28th day, there was no significant difference between groups. Aggressive behavior was limited to responses in the test situation, Dr. Kouri notes; participants did not display overt hostility. “At this point we do not know exactly how these findings reflect changes in aggressive behavior outside the laboratory,” Dr. Kouri says. “But the results demonstrate that abstinence is associated with unpleasant behavioral symptoms that may contribute to continued drug use.”

Other Withdrawal Symptoms
Studies at Columbia University in New York City have demonstrated that, in addition to aggression, marijuana smokers experience other withdrawal symptoms such as anxiety, stomach pain, and increased irritability during abstinence from the drug. “These results suggest that dependence may be an important consequence of repeated daily exposure to marijuana,” says NIDA-supported researcher Dr. Margaret Haney.

Dr. Haney and her colleagues investigated the effects of abstinence on 12 adult males with an average age of 28 years who, in the laboratory, smoked marijuana with THC concentrations of 3.1 percent or 1.8 percent, or marijuana cigarettes containing no active THC. All participants smoked inactive marijuana during the first 4 days of the study followed by either the high concentration, low concentration, or inactive marijuana on alternating 4-day periods. Three times each day, the participants completed a 50-item checklist that rated physical conditions such as hunger, dizziness, and headache and aspects of their mood, for example, anxiety, talkativeness, friendliness, or depression.

“The withdrawal symptoms are not as dramatic as those associated with withdrawal from opiates or alcohol, but are still significant.”
Abstinence from either high or low-concentration marijuana resulted in reduced hunger, decreased ratings of “friendly” and “content,” and increased ratings of “irritability,” “stomach pain,” and “anxiety.” Moreover, Dr. Haney notes, participants receiving high-concentration marijuana rated the drug’s effects higher (“good drug effect,” “stimulated,” “high”) on the first day of exposure than on the fourth day, indicating the development of tolerance to THC.
“It appears likely that the onset of the withdrawal symptoms we observed in this study may contribute to maintaining chronic marijuana use,” Dr. Haney says. “The withdrawal symptoms are not as dramatic as those associated with withdrawal from opiates or alcohol, but are still significant to the individual marijuana user. These symptoms must be taken into account in order to develop effective treatment programs for marijuana abuse.”

Kouri, E.M; Pope, HG.; and Lukas, S.E. Changes in aggressive behavior during withdrawal from long-term marijuana use. Psychopharmacology, 143:302-308, 1999.
Haney, M; Ward, A.S.; Corner, S.D.; Foltin, R. W.; and Fischman, M W.
Abstinence symptoms following smoked marijuana in humans.
Psychopharmacology,141:395-404, 1999.

Study Finds Marijuana Ingredient Promotes Tumour Growth, Impairs Anti-Tumour Defences

Researchers report in the July 2000 issue of the “Journal of Immunology” that tetrahydrocannabinol (THC), the major psychoactive component of marijuana, can promote tumor growth by impairing the body’s anti-tumor immunity system. While previous research has shown that THC can lower resistance to both bacterial and viral infections, this is the first time that its possible tumor-promoting activity has been reported.
A team of researchers at UCLA’s Jonsson Comprehensive Cancer Center found in experiments in mice that THC limits immune response by increasing the availability of two forms (IL-b and TGF-13) of cytokine, a potent, tumor-specific, immunity suppresser.
The authors also suggest that smoking marijuana may be more of a cancer risk than smoking tobacco. The tar portion of marijuana smoke, compared to that of tobacco, contains higher concentrations of carcinogenic hydrocarbons, including benzapyrene, a key factor in promoting human lung cancer. And marijuana smoke deposits four times as much tar in the respiratory tract as does a comparable amount of tobacco, thus increasing exposure to carcinogens.
Dr. Steven M. Dubinett, head of the research team that conducted the study, says, “What we already know about marijuana smoke, coupled with our new finding that THC may encourage tumor growth, suggests that regular use of marijuana may increase the risk of respiratory tract cancer and further studies will be needed to evaluate this possibility.”
The UCLA researchers examined the effects of THC on the immune response to lung cancer in mice. Over a two-week period, the animals were injected four times per week with either THC or a saline solution. Fourteen days after the injections were started, murine Lewis lung cancer and line 1 alveolar cell cancer cells were implanted in the mice. The mice continued to receive THC or saline injections after the tumor cells were implanted, and tumor growth was assessed three times each week. To test the hypothesis that THC impairs tumor-specific immune system response, a group of mice with compromised immune systems was also studied.
The researchers found that in the mice with normal immune systems there was significant enhancement of tumor growth, but THC had no effect on tumor growth in the immunodeficient mice. The study also showed that when lymphocytes from the THC-treated mice were injected into untreated mice, the immune deficit was transferred and tumor growth was accelerated in the normal controls.
Additionally, the UCLA research team demonstrated that when anti-IL-10 and anti-TGF-B were administered, there was no acceleration of tumor growth in THC-treated mice. These results suggest that enhanced tumor growth is prompted by THC’s ability to stimulate production of IL-10 and TGF-B, which inhibits anti-tumor immune response.

Roun et al. Biological Psychology Laboratory at Maclean Hospital Limited in haemorrhage Notes Vol. 15, No. 1

Cocaine Use, Hypertension Major Risk Factors For Brain
Haemorrhage In Young African Americans

Young African Americans who use cocaine are six times more likely to suffer a potentially lethal episode of bleeding inside the brain than non-users, a case-control study of major risk factors for intracerebral haemorrhage in this population conducted by researchers at the University of Buffalo and Emory University has found. The study, published in the July issue of Ethnicity and Disease, also shows twice the incidence of hypertension and five times the number of people with hypertension who weren’t taking their blood-pressure medicine among those who had had an intracerebral haemorrhage, compared to healthy, age-matched controls. Alcohol use also was associated with an increase in risk.

“African-American patients experience a two-fold higher risk of intracerebral hemorrhage compared to white patients,” said Adnan I. Qureshi, UB assistant professor of neurosurgery and lead author on the study. “This high incidence of intracerebral haemorrhage contributes significantly to death, disability and loss of productivity in young populations.

“In the absence of any definitive treatment for intracerebral haemorrhage, significant stress needs to be placed on primary prevention and understanding of factors that predispose to a higher risk in young African Americans,” he said.

Internal bleeding, also known as intracerebral haemorrhage (ICH), can occur in any part of the brain. Blood may accumulate in the tissues as well as in the space between the brain and the membranes covering the brain, a subarachnoid haemorrhage. Bleeding may be isolated in a part of one cerebral hemisphere (lobar intracerebral haemorrhage) or occur in other brain structures, such as the thalamus, basal ganglia, pons, or cerebellum (deep intracerebral haemorrhage).

ICH occurs in about 20 out of 100 000 people, statistics show, and can affect any person regardless of age, sex or race, but appears to occur more frequently in African Americans, striking the young and middle-aged disproportionately. The incidence of intracerebral haemorrhage in African Americans reaches nearly 50 out of 100 000 persons, Qureshi noted.

Since there is no effective treatment for ICH, prevention takes center stage, but little information has been available on the factors that put this population at higher risk. This study is the first to use a case-control approach to tease out these risks. It assessed health and lifestyle histories of 122 African Americans between the ages of 18 and 45 admitted to a public hospital in Atlanta with ICH between December 31, 1997, and January 1, 1990. This information was compared with data from 366 African Americans in the same age group without the condition who took part in the most recent National Health and Nutrition Examination Survey (NHANES Ill).

Researchers included data on hypertension, diabetes, smoking, cocaine use, alcohol use, and stroke or heart disease from all participants, as well as the record of prescriptions for hypertension medication and compliance with their use.

Results showed that cocaine use was the strongest risk factor associated with ICH in this population, even higher than hypertension, Qureshi said. “While the mechanism for this association isn’t clear, we suspect that the sudden elevation in blood pressure that occurs immediately after using cocaine may cause an existing aneurysm or artenovenous malformation (AVM) in the brain to rupture.” Several clinical studies of stroke among cocaine users have found a high frequency of aneurysm or AVM, he noted.

Hypertension, particularly in those who had been prescribed medication but took it irregularly, also was shown to be an important high-risk factor for ICH. These findings suggest that physicians should focus more on compliance than on screening, Qureshi said.

“In chronic hypertension, the body develops a certain protective response in an effort to counter high blood pressure’s effects. Taking blood-pressure medication intermittently may impair the development of this response and may make patients more vulnerable to blood pressure fluctuations.”

The bottom line, Qureshi said, is that a reduction in the high rate of death and disability associated with intracerebral haemorrhage can’t occur without effective preventive measures.

“The study demonstrated the presence of factors in the community that easily can be modified to reduce this risk. These include avoidance of cocaine use and regular use of blood pressure medication as prescribed.”

Fareed et al, Dept. Neurosurgery, UB Sch. Medicine and Biomedical Sciences; and Mohammad et al, Dept. Neurology, Emory University School of Medicine.

Drug that curbs Nicotine Craving may do same for Cocaine

A drug that Duke University Medical Center researchers have successfully used to help some people quit smoking may also help curb cocaine cravings, according to studies conducted in rats.

The drug mecamylamine, used in combination with nicotine to help reduce the urge to smoke cigarettes, has now been shown in animal studies to reduce their self-administration of cocaine. Rats that were trained to press a lever in order to get cocaine no longer pressed it with the same frequency after they were given mecamylamine, said Edward Levin, lead author of the study. When injected with mecamylamine, the mice infused cocaine 11 times per hour, versus 19 times per hour when they received a placebo injection of saline – a reduction of more than 40 percent. “It’s always very exciting when a drug used for one addiction has implications for a broader range of addictive drugs,” said Levin, whose study was funded by the National Institutes of Health. Mecamylamine is an older medication originally used to treat high blood pressure. Researchers now know it blocks some of nicotine’s ability, and potentially that of other drugs, to generate feelings of pleasure in the brain. Levin said it works by occupying specific sites, called “nicotinic receptors,” on nerve cells where nicotine would normally act. When mecamylamine blocks these receptors, nicotine can no longer exert its full action, that of stimulating the release of dopamine. Dopamine is the primary brain chemical involved in generating pleasure. Drugs like nicotine, alcohol and cocaine all increase available amounts of dopamine and thereby increase the pleasure sensation, said Jed Rose, chief of the Nicotine Research Program at Duke and study co-author. Eventually, the brain may prefer the drug over natural rewards like food or sex, and hence, the person can become addicted. Mecamylamine blocks the action of nicotine, and potentially cocaine, by lowering the net amount of dopamine available in the brain. While cocaine still boosts available levels of dopamine, its overall amount is decreased because mecamylamine has plugged up some of the nicotinic receptor sites where the brain would naturally be activating its own dopamine. “In other words, the brain has its own chemical, acetylcholine, that stimulates the release of dopamine. Mecamylamine comes along and occupies some of the nicotinic acetylcholine receptor sites and prevents them from activating dopamine,” Rose said. “So the net effect is that less dopamine is being produced, even when cocaine comes along and boosts dopamine levels through a different pathway.” Rose said the person still desires nicotine or cocaine, but the desire is weakened because the brain is no longer being flooded with dopamine. “Mecamylamine reduces desire, but it doesn’t quench it,” he said. “Yet given how few medications there are to combat serious addictions, even a medication that reduces craving can be of significant benefit.” Already, mecamylamine has proven to be of significant benefit in helping people quit smoking.

In earlier Duke studies, Rose demonstrated that using a patch with nicotine and mecamylamine together helped 40 percent of smokers quit for at feast one year, while only 15 percent of smokers were able to do so using the patch alone. The researchers expect mecamylamine to be approved for smoking cessation sometime this year.

Rose et al. International Behavioural Neuro Science Society, April, 2000.

Trauma and stress in early life increases vulnerability to cocaine addiction in adulthood.

The trauma that a majority of drug addicts suffer in early life has now been shown to increase their vulnerability to drug addiction, Yale researchers report in a new study. “Using well-established animal models, we’ve found strong evidence that early life stress enhances vulnerability to drug addiction,” said Therese A. Kosten, assistant professor of psychiatry at Yale School of Medicine. “This study demonstrates the need to target drug abuse prevention strategies to children with early life traumas.”
Rat pups that were separated from their mothers for one hour per day during the first week of life learned to self-administer cocaine more readily when they were adults compared to rats that had not had this early life stress. This effect was not due to differences in learning or general activity levels. “Previous studies show that most drug addicts have had early life trauma,” said Kosten, principal investigator on the study. “Given that 1.8 million Americans are currently using cocaine, this information will be valuable in directing future research toward potential interventions for children with early stress experiences in order to reduce the risk of developing drug addiction in adults.”
Kosten and her team tested 14 adult rats, eight of which had experienced the stress of isolation from their mother, siblings and nest three months earlier. Compared to six rats that had not experienced this stress, isolated rats learned to press a lever to receive a cocaine infusion in two-thirds the number of days, and at half the dose needed for the non-isolated rats. Kosten said the groups did not differ in the number of days to learn to press a lever to receive food pellets, demonstrating that the isolation effect was specific to cocaine.

(Source: Kosten et al. Yale School Medicine
Published in Brain Research Journal 2000)

Opiate and Cocaine Exposed Newborns: Growth
This investigation examined growth parameters at birth in 204 infants born to mothers who used cocaine and/or opiates during pregnancy. Analyses considered both type (cocaine, opiate or both) and pattern of in utero drug exposure. A unique feature of the investigation was the large group of opiate exposed infants. Singleton newborn infants born to cocaine and/or opiate using mothers, were recruited. Using a structured interview and urine toxicology screens, information was obtained on the type and pattern of in utero drug exposure for each infant. Outcome measures included birth weight, length, and head circumference. Birth weight and length were significantly different by type of drug exposure with the opiate only infants the largest (p=.0001) and longest (p=.008). Differences in head circumference size were not statistically significant (p=.58). Mean Z-scores were I S.D. lower for birth weight and length and 1.5 S.D. lower for head circumference when compared to National Center for Health Statistics (NCHS) growth standards. This study provides support that in utero cocaine exposure may confer more risk for somatic growth retardation at birth than opiate exposure even when controlling for nicotine and alcohol exposure, amount of prenatal care, gender, maternal age, education and marital status.

(Source: Butz et al. “Opiate and Cocaine Exposed Newborns: Growth Outcomes”, ‘Child & Adolescent Sub. Abuse’, 1-16, 1999)

Vaccine Against Effects Of Cocaine Nearly Ready For Clinical Trials

Researchers at The Scripps Research Institute have developed a second-generation, long-lived cocaine immunoconjugate that blocks cocaine passage into the brain of rats.
The new immunoconjugate displays two amide groups in the stereochemical configuration found in the cocaine framework, so that antibody affinity to cocaine is optimized, Dr. Janda and associates report in the Proceedings of the National Academy of Sciences.
Rats were immunized with the vaccine and challenged with systemic cocaine. Compared with unimmunized controls, locomotor activity was significantly reduced, as were stereotypic patterns of behavior, such as sniffing and rearing. Effects were sustained throughout the 12 days of the study.
“We have been able to tap into the immune system to immobilize antibodies to recognize cocaine as foreign and remove it from the body,” Dr. Janda said. “The current vaccine provides a much longer lasting effect than our previous vaccines, suggesting that boosting requirements would be minimal and the antibody circulation time would be increased.”
Dr. Janda added that the vaccine would be of most use in addicts who are motivated to stop using cocaine. “Typically an addict will relapse several times before he or she will ‘kick’ the drug,” he said. “We believe the vaccine will protect addicts at weak moments when they have the urge to get high. If we can prevent the high we can prevent relapse and this would speed the process of kicking the addiction.”

(Source: Proc National Academy of Science, USA 2001;98:1988-1992.)